Gout and hyperuricaemia: modifiable cardiovascular risk factors?

Abstract

Gout and hyperuricaemia are two clinical situations associated with an elevated risk of developing cardiovascular (heart failure, myocardial infarction, stroke) and metabolic and renal complications. One reason is probably related to the fact that the prevalence of hyperuricaemia and gout is high in clinical situations, which themselves involve a high cardiovascular risk, such as hypertension, diabetes, chronic kidney disease or obesity. However, recent studies suggest that hyperuricaemia may promote cardiovascular complications independently of other cardiovascular risk factors, by inducing chronic inflammation, oxidative stress, and endothelial dysfunction. The questions that arise today concern primarily the treatment of asymptomatic hyperuricaemia. Should it be treated to decrease the patients' cardiovascular risk and if so, starting from which level and towards which target? There are now several pieces of evidence indicating that this might be useful, but data from large studies are not unanimous. This review will discuss this issue as well as new well-tolerated treatments, such as febuxostat or SGLT2 inhibitors, which lower uric acid levels, prevent gout and lower the risk of cardio-renal events.

2023 ESH Guidelines for the management of arterial hypertension The Task Force for the management of arterial hypertension of the European Society of Hypertension

“…The recently reported preventive role of colchicine against atherosclerotic disease [1526], presumably via reduction of its contribution to inflammation and atherosclerosis, requires confirmation. This is required also for the CVprotective effect of reducing serum uric acid by antiuricemic agents, which has been suggested by earlier studies [1522,1524] but recently denied by a RCT with allopurinol in patients with CAD [1527,1528].…”

The Prevalence of Hyperuricemia and the Association Between Hyperuricemia and Age in Patients with Psychiatric Disorders to a General Hospital: A Cross-Section Study

“…Previous articles have shown that oxidative stress might be of importance in the pathophysiology of BD. 14 Elevated SUA has been associated with mood-related disorders. Previous studies have found that the level of SUA in patients with depression and anxiety was lower than that in normal control; and the severity and duration of symptoms were negatively associated with uric acid.…”

“…HUA is not only the pathological underlying cause of gout but is also an independent risk factor for obesity, 4 , 5 hypertension, 6 , 7 diabetes, 8 dyslipidemia, 9 , 10 liver dysfunction, 11 kidney dysfunction, 12 metabolic syndrome 13 and cardiovascular disease. 14 …”

“…HUA is not only the pathological underlying cause of gout but is also an independent risk factor for obesity, 4,5 hypertension, 6,7 diabetes, 8 dyslipidemia, 9,10 liver dysfunction, 11 kidney dysfunction, 12 metabolic syndrome 13 and cardiovascular disease. 14 Purine metabolism can influence the activity of other neurotransmitters, including dopamine and gamma-aminobutyric acid (GABA) energy, which are involved in the pathophysiology of emotion-related diseases. 15,16 Previous studies have shown that the purine system is associated with a variety of neuropsychiatric disorders, 17 including disturbance of sleep, 18 anhedonia, 19 a drop in energy, cognitive impairment, 20 and psychomotor agitation.…”

Prevalence of hyperuricaemia among adults from Ningxia Hui Autonomous Region, China: a cross-sectional study

“…2 HUA is widely recognised as the primary cause of gout onset and is also associated with several health consequences, including hypertension, diabetes, metabolic syndrome (MetS), liver dysfunction, kidney dysfunction and cardiovascular disease. [3][4][5][6][7][8][9][10][11] Therefore, it is critical to understand the SUA level and the prevalence of HUA in community healthcare and health policymaking.…”